Letter to the Editor
Emergency department falls interventions improve osteoporosis management in frail older adults
Dear Editor,
Singapore’s population is ageing rapidly and by 2030, around 1 in 4 citizens will be aged 65 and above.1 Older adults represent 21–40% of emergency department (ED) users and proportionally are the highest users of ED services.2
One-third of community dwellers over 65 years of age fall each year,...
Original Article
Transitional care strategies at emergency department for elderly patients: A multicentre study in Singapore
In Singapore, greater efforts are being directed towards developing an integrated health and social ecosystem under the new Healthier SG strategy announced by the Ministry of Health. This life-course approach aims to promote overall healthier living in collaboration with key community partners (e.g. intermediate and long-term care service providers)...
Letter to the Editor
Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department
Dear Editor,
Nitrous oxide (N2O) produces dissociative euphoria, amnesia and analgesia, and is a common sedative for procedural sedation in paediatric emergency departments (EDs) due to its non-parenteral administration and good safety profile.1-3 Suitable procedures include fracture reduction, toilet and suturing, incision and drainage, and application of burn dressings. The...
Commentary
Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore
Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED) with blunt or penetrating major trauma. “Trauma team activation” is initiated by the ED specialist through the hospital call-centre, and is a process that mobilises...
Editorial
Frequent attenders to multiple emergency departments in Singapore
The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input)...
Commentary
Cardiac sarcoidosis: Difficulties in diagnosis and treatment
Sarcoidosis is a multisystem, granulomatous disorder of unknown aetiology. It affects the lungs in 90% of cases, but is also known to affect other organs including the skin, liver, spleen, kidneys and heart.1 Cardiac sarcoidosis (CS) is thought to clinically affect 5% of those with sarcoidosis, manifesting as conduction...
Review Article
Circular RNAs in the pathogenesis of sepsis and their clinical implications: A narrative review
Sepsis is a condition with life-threatening organ dysfunction, resulting from abnormal responses of the host to various infections.1 The underlying pathogenic mechanisms include an imbalanced inflammatory response, immune disorder, neuroendocrine abnormality, coagulopathy, mitochondrial damage and endoplasmic reticulum stress.2 A recent study reported that the age-standardised sepsis incidence rate fell...
Review Article
Determinants of emergency department utilisation by older adults in Singapore: A systematic review
Older adults in Singapore contribute to a disproportionately higher number of visits to the emergency department (ED), mirroring trends around the world.1,2 For instance, hospital admissions among those aged ≥65 years have been on the rise from 2018 to 2020, contributing a growing burden to ED services over the...
Others
Cryptococcal Prostatic Abscess in an Immunocompromised Patient: A Case Report and Review of the Literature
Cryptococcosis is a well-recognised infection in immunocompromised patients, although its prevalence varies with the type of immune defect. We report a patient with myasthenia gravis (MG) on steroid therapy and non-insulin dependent diabetes mellitus (NIDDM) who developed cryptococcal meningitis and in whom a search for a persistent focus by...
Others
The Role of Cytokines and Cytokine Gene Polymorphism in T-cell Activation and Allograft Rejection
Cytokines are peptide molecules that are responsible for intercellular signalling during immune activation events. Cytokines are responsible, in large part, for the regulation of all local and systemic immune inflammatory and immunoregulatory events.
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Original Article
The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint
Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition has been sporadic.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
15th Seah Cheng Siang Memorial Lecture: Liver Transplantation – Lessons Learnt and Future Horizons
It is a great honour to be giving this lecture – the 15th, in memory of Professor Seah, who by all accounts was truly a great doctor, not only in the care he gave to his patients but in his dedication over many years to the advancement of medicine...
Original Article
When the Stork Arrives Unannounced – Seven Years of Emergency Deliveries in a Non-obstetric General Hospital
Emergency department (ED) deliveries are uncommon in the Singapore setting, as patients presenting with labour to the ED are sent to the obstetric suites in Kandang Kerbau Women’s and Children’s Hospital (KKH), National University Hospital (NUH) and Singapore General Hospital upon arrival. The same applies to the various private...
Original Article
Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department
Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in many Emergency departments (EDs), where many conditions have time-dependent outcomes, and accurate and quick blood results are thus important.
This article is available only as a...
Others
Cyclosporin-induced Sebaceous Hyperplasia in Renal Transplant Patients
There are several reports in the literature of sebaceous hyperplasia being induced by cyclosporin in immuno-suppression of organ transplant patients. The condition was only found in male transplant patients and not seen in children with renal transplant. Two Chinese renal transplant recipients who developed sebaceous hyperplasia while on cyclosporin...
Others
Tuberculosis Post-Liver Transplantation: A Rare but Complicated Disease
Tuberculosis (TB) is a serious opportunistic infection in transplant recipients, with an incidence in organ transplant recipients ranging from 0.35% in developed countries to 15% in endemic areas.1 It carries a mortality rate of as high as 40%.2 The majority of TB infection have occurred within 12 months of...
Review Article
Current Biologic Agents in the Treatment of Uveitis
Uveitis is a general term describing inflammation of one or all parts of the uveal tract. Deleterious effects on vision, either by acute ocular inflammation or by its sequelae, such as cataracts, glaucoma and retinal vascular ischaemia, make uveitis one of the major causes of visual loss.1 Uveitis can...
Original Article
Predicting Positive Blood Cultures in Patients presenting with Pneumonia at an Emergency Department in Singapore
Pneumonia is the fourth leading cause for hospitalisation, and the third leading cause of death in Singapore.1 Overall, it is consistently one of the most expensive diseases to treat among elderly persons with multiple co-morbid conditions,2 a challenge to our healthcare system with a rapidly ageing population. Treatment guidelines...
Commentary
The Role of Research in Transplantation
Organ and bone marrow transplantation have been extraordinary success stories in medicine during the past 50 years. A large and important clinical service has been developed in both these subjects and there has been a staggering improvement in the overall results of transplantation of patients who previously were offered...
Original Article
Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients
The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in which there are pathologies in the vessels nourishing the brain. Besides being a serious health problem due to its high mortality and morbidity, stroke is...
Original Article
An Observational, Prospective Study to Determine the Ease of Vascular Access in Adults Using a Novel Intraosseous Access Device
Intravascular access is a vital component of emergency care and resuscitation. There is nothing more frustrating for the emergency physician than the inability to administer fluids or medications just because of the inability to obtain intravascular access. Rapidly securing vascular access will allow for the administration of fluids, pressor...
Original Article
Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation
The development of new-onset diabetes after transplantation (NODAT) is a serious metabolic complication of kidney transplantation that predisposes patients to graft dysfunction, cardiovascular disease and death. Although NODAT has been recognised for many years, the true incidence has been difficult to establish due to inconsistencies in the definition of...
Original Article
External Validation of the Cham Score for Ordering of Blood Cultures in Emergency Department Patients with Non-Hospital Acquired Pneumonia
Some guidelines currently promote the taking of blood cultures in patients admitted to hospital with non-hospital acquired pneumonia in order to identify pathogens and guide therapy. Previous studies have reported that the proportion of patients returning a true positive blood culture is between 2.1% and 9%. False positive cultures...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during COVID-19-related lockdowns. Notably, there have been reports that patients with acute emergencies such as strokes and heart attacks are either not seeking treatment, or are...
Letter to the Editor
Decrease in emergency department attendances during COVID-19 especially in school-going children
Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with minor ailments, but these observations have yet to be evaluated in Singapore. We investigated ED attendances during the coronavirus disease 2019 (COVID-19) pandemic in Singapore.
This...